Medical devices with detachable pivotable jaws

ABSTRACT

Medical systems, devices and methods are provided for engaging tissue, e.g. for clipping tissue, closing a perforation or performing hemostasis. Generally, the medical system including a housing, first and second jaws rotatable relative to the housing, a driver, and an elongate drive wire. The elongate drive wire may be disconnected from the driver, first and second jaws, and the housing, which are left in vivo engaged with the tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. patent application Ser. No.14/568,841 filed on Dec. 12, 2014, which is Divisional of U.S. patentapplication Ser. No. 13/270,834 filed on Oct. 11, 2011 (now U.S. Pat.No. 8,939,997), which claims the benefit of U.S. Provisional PatentApplication Ser. No. 61/391,878 filed on Oct. 11, 2010. U.S. patentapplication Ser. No. 13/270,834 is also a Continuation-In-Part of U.S.patent application Ser. No. 12/971,873 filed on Dec. 17, 2010 (now U.S.Pat. No. 8,771,293), which claims the benefit of U.S. Provisional PatentApplication Ser. No. 61/289,297 filed on Dec. 22, 2009, to which thebenefit of and priority to are also claimed in the present application.All of the foregoing applications are hereby incorporated by referencein their entirety.

BACKGROUND

Conventionally, a clip may be introduced into a body cavity through anendoscope to grasp living tissue of a body cavity for hemostasis,marking, and/or ligating. Such clips are often known as surgical clips,endoscopic clips, hemostasis clips and vascular clips. In addition,clips are now being used in a number of applications related togastrointestinal bleeding such as peptic ulcers, Mallory-Weiss tears,Dieulafoy's lesions, angiomas, post-papillotomy bleeding, and smallvarices with active bleeding. Clips have also been attempted for use inclosing perforations in the stomach

Gastrointestinal bleeding is a somewhat common and serious conditionthat is often fatal if left untreated. This problem has prompted thedevelopment of a number of endoscopic therapeutic approaches to achievehemostasis such as the injection of sclerosing agents and contactthermo-coagulation techniques. Although such approaches are ofteneffective, bleeding continues for many patients and corrective surgerytherefore becomes necessary. Because surgery is an invasive techniquethat is associated with a high morbidity rate and many other undesirableside effects, there exists a need for highly effective, less invasiveprocedures.

Mechanical hemostatic devices such as clips have been used in variousparts of the body, including gastrointestinal applications. One of theproblems associated with conventional hemostatic devices and clips,however, is that many devices are not strong enough to cause permanenthemostasis. Further, clips have also been attempted for use in closingperforations in the stomach or gastrointestinal structures, butunfortunately traditional clips suffer from difficult placement and thecapability to grasp a limited amount of tissue, potentially resulting inincomplete closure.

SUMMARY

The invention may include any of the following aspects in variouscombinations and may also include any other aspect described below inthe written description or in the attached drawings.

In a first aspect, a medical device is provided for engaging tissue, themedical device including a housing, first and second jaws, a driver, anelongated drive wire and an elongated tubular member. The housingdefines an internal passageway and a longitudinal axis extending betweenproximal and distal ends of the housing. The first and second jaws arerotatable relative to the housing and have proximal and distal ends. Thedriver is engaged with the proximal ends of the first and second jaws,wherein longitudinal movement of the driver rotates the first and secondjaws relative to the housing. The elongated drive wire is selectivelyconnected to the driver for longitudinal movement therewith, and thedrive wire has an enlarged portion proximate a distal end of the drivewire. The elongate tubular member defines a lumen sized to slidablyreceive a connection block. The connection block defines a bore slidablyreceiving the drive wire, wherein the enlarged portion of the drive wirehas a size that is larger than the bore and is positioned on a distalside of the connection block. The connection block is operable betweenan extended position and a retracted position. The connection blockprojects from the tubular member in the extended position and isstructured to engage a proximal end of the housing. The connection blockis positioned within the lumen of the tubular member in the retractedposition and disengaged from the housing. The enlarged portion of thedrive wire engages the connection block upon proximal retraction of thedrive wire to operate the tubular member from its extended position toits retracted position and disengage the connection block from thehousing.

According to further detailed aspects, the connection block ispreferably sized to frictionally engage the housing. The connectionblock may include a connection ring having a plurality of tabs, whereinthe housing includes a plurality of slots extending to a proximal end ofthe housing that receive the plurality of tabs. The plurality of slotsmay each include a narrowed throat separating proximal and distalportions of the slots. The housing may further include a plurality ofslits formed therein, the slits each connected to a distal portion ofthe slots to improve flexibility of the housing. The connection blockincludes a distal flange and a proximal flange defining a reduceddiameter portion therebetween, and the tubular member includes one of apin and a tab projecting into the lumen and positioned within thereduced diameter portion to limit longitudinal movement of theconnection block. The connection block may also include a compressiblemember attached thereto and sized to be compressed between an interiorof the housing and an exterior of the connection block.

According to further detailed aspects, the system may also include anattachment member attached to a distal end of the tubular member, theattachment member including a passageway in communication with the lumenof the tubular member. The attachment member preferably includesdiametrically opposing openings between ends of the attachment member incommunication with the passageway. The connection block includes adistal flange and a proximal flange defining a reduced diameter portiontherebetween, and the attachment member preferably includes at least onetab projecting into the lumen and positioned within the reduced diameterportion to limit longitudinal movement of the connection block, the tabunitarily and integrally formed with the attachment member. The systemmay also include a locking pin having a forked strut defined by twotines having a slot therebetween. The slot is sized to receive the drivewire therein, and the forked strut sized to pass through the opposingopenings in the attachment member and limit longitudinal movement of theconnection block. The system may still further include an applicatorhaving a left body slidably attached to a right body, the left and rightbodies including channels sized and shaped to receive portions of thetubular member and attachment member and maintain their positionrelative to the applicator. The channels are also sized and shaped toreceive portions of the locking pin, whereby relative translation of theleft and right bodies positions the forked strut of the locking pininto, or out of, the opposing openings in the attachment member.Alternatively, the applicator may simply have a main body and a forkedstrut projecting from the main body, the forked strut defined by twotines having a slot therebetween, the slot sized to receive the drivewire therein, the forked strut sized to pass through the opposingopening in the attachment member and limit longitudinal movement of theconnection block.

According to still further detailed aspects, the enlarged portion of thedrive wire is an enlarged distal head, and the driver includes a socketfacing proximally and receiving the distal head. The driver isconstructed of a resilient material that flexes to adjust the size ofthe socket. The socket is sized to selectively receive the enlargeddistal head of the drive wire. A locking tab may be positioned at anentrance to the socket and moves to vary the size of the entrance.Preferably, the driver includes two locking tabs on opposing sides ofthe socket, and the housing includes a guide surface guiding thelongitudinal movement of the driver, the guide surface including twosurfaces on opposing sides of the housing corresponding to the twolocking tabs. The housing may also define a shoulder at the transitionbetween the proximal portion and distal portion of the guide surface,wherein the locking tab is positioned to engage the shoulder to limitlongitudinal movement of the driver. The shoulder preferably deflectsthe tab to a position into engagement with the shoulder when a distallydirected longitudinal force on the driver reaches a predetermined forceto permit longitudinal movement of the driver and the first and secondjaws in a distal direction.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings incorporated in and forming a part of thespecification illustrate several aspects of the present invention, andtogether with the description serve to explain the principles of theinvention. In the drawings:

FIG. 1 is a top view of a medical system having a medical device forengaging tissue, constructed in accordance with the teachings of thepresent invention;

FIG. 2 is a top view similar to FIG. 1, but showing the outer structuresin dotted lines and the interior sections in solid lines and partialcross section;

FIG. 3 is a side view of the medical system and device depicted in FIG.1;

FIG. 4 is a side view similar to FIG. 3, but showing the outerstructures in dotted lines and the interior structures in solid linesand partial cross section

FIG. 5 is a side view of a medical device that is part of the medicalsystem depicted in FIGS. 1-4;

FIG. 6 is a front view of a housing forming a portion of the medicalsystem and device depicted in FIGS. 1-5;

FIG. 7 is a perspective view of the housing depicted in FIG. 6;

FIGS. 8-12 are side views showing operation of the medical system anddevice depicted in FIGS. 1-5;

FIGS. 13 and 14 are top views, partially in cross-section, depictingoperation of the medical system and device depicted in FIGS. 1-4;

FIGS. 15 and 16 are cross-sectional views showing operation of themedical system depicted in FIGS. 1-4.

FIG. 17 is a perspective view of an alternate embodiment of a connectionblock forming a portion of the medical system of FIG. 1;

FIG. 18 is a front view showing the connection block of FIG. 17;

FIG. 19 is a perspective view of an alternate embodiment of the housingforming a portion of the medical system and medical device of FIG. 1;

FIGS. 20-22 show steps of operating the medical system depicted in FIGS.17-19;

FIG. 23 is a perspective view of another alternate embodiment of aportion of the medical system and device depicted in FIG. 1;

FIG. 24 is a perspective view of another embodiment of the medicalsystem depicted in FIG. 1;

FIG. 25 is a side view of the medical system depicted in FIG. 24;

FIG. 26 is a perspective view of a locking pin forming a portion of themedical system depicted in FIGS. 21-25;

FIGS. 27-28 are perspective views showing operation of an applicator forthe locking pin depicted in FIG. 26; and

FIG. 29 is a perspective view of an alternate embodiment of theapplicator depicted in FIGS. 27 and 28.

DETAILED DESCRIPTION

The terms “proximal” and “distal” as used herein are intended to have areference point relative to the user. Specifically, throughout thespecification, the terms “distal” and “distally” shall denote aposition, direction, or orientation that is generally away from theuser, and the terms “proximal” and “proximally” shall denote a position,direction, or orientation that is generally towards the user.

An exemplary medical system 20 having a medical device 40 for engagingtissue T (FIG. 11) is shown in FIGS. 1 through 4. The medical system 20and device 40 are generally sized and structured for operation throughthe working channel of an endoscope (not shown) or other scope, althoughthe system 20 and device 40 may also be used alone or in conjunctionwith other elongate devices such as catheters, fiber-optic visualizationsystems, needles and the like. Generally, the medical system 20 includesa drive wire 22 slidably housed within the distal end 23 of an elongatedcatheter 24 for selective connection to, and operation of, the medicaldevice 40. As will be described in further detail herein, the medicaldevice 40 generally includes a housing 42 having a first jaw 44 and asecond jaw 46 pivotally connected thereto for engaging the tissue T.Generally, the jaws 44, 46 have been shown as forming grasping forceps,although the jaws are intended to be used to clip tissue, e.g. to closean opening or for hemostasis. Accordingly, it will be recognized thatthe shape and structure of the jaws may take many forms and serve manypurposes and functions, all in accordance with the teachings of thepresent invention.

In the medical system 20, the drive wire 22 slidably extends through thecatheter 24. Although the term “wire” is used to refer to the drive wire22, it will be recognized that any elongate control member capable oftransmitting longitudinal force over a distance (such as is required intypical endoscopic, laparoscopic and similar procedures) may be used,and this includes plastic rods or tubes, single filament ormulti-filament wires and the like. A connection block 26 is slidablyfitted within the distal end 23 of the catheter 24 and defines a bore 28therethrough which slidably receives the drive wire 22. The exterior ofthe connection block 26 includes a recessed portion 27, and two pins 30(e.g., formed from stainless steel wire) are connected to the catheter24 and positioned within the recessed portion 27 to limit thelongitudinal movement of the connection block 26.

A distal end of the drive wire 22 defines a distal head 32 that is sizedlarger than the drive wire 22, and likewise larger than the bore 28 inthe connection block 26. As will be described later herein, the distalhead 32 is used to slide the connection block 26 within the catheter 24to disconnect the medical device 40 from the medical system 20. As alsoseen in FIGS. 1-4, the housing 42 of the medical device 40 is a tubularmember defining an interior space 43. A proximal end of the housing 42frictionally receives a distal end of the connection block 26 within theinterior space 43 for selective connection therewith.

The internal passageway 43 of the housing 42 also receives the first andsecond jaws 44, 46 and a driver 48 which is used to interconnect thedrive wire 22 to the jaws 44, 46. As best seen in FIGS. 1, 2 and 5, thedriver 48 has a proximal portion which defines a socket 50 sized toreceive enlarged distal head 32 of the drive wire 22. At the proximalentrance of the socket 50, two deflectable locking tabs 52 are formedwhich rotate relative to the remainder of the driver 48 to increase ordecrease the size of the socket 50. The locking tabs 52 may beseparately formed and pivotally attached to the driver 48, or may beintegrally formed with the driver 48 and formed of a resilient materialwhich flexes to permit rotation of the locking tabs 52 radially inwardlyand radially outwardly. Preferably the locking tabs 52 are plasticallydeformable, such that they may be locked to the drive wire 22 or to thehousing 42, as discussed further herein.

A distal portion of the driver 48 defines a rack 54 for engaging andoperating the jaws 44, 46. In the depicted embodiment, the rack 54includes a central spine 56 having teeth 58 projecting away from thecentral spine 56 and on opposite sides of the spine 56. One set of teeth58 on one side of the spine 56 generally operate the first jaw 44 whilethe other set of teeth 58 on the other side of the spine 56 operate thesecond jaw 46. It will be recognized that the rack 54 may include asingle set of teeth or other geared structures that interface with thejaws 44, 46.

As best seen in FIG. 5, the first and second jaws 44, 46 include distalends 60, 62 that are structured to grasp and engage tissue, generallythey have a talon shape as disclosed in 61/141,934 filed Dec. 31, 2008,the disclosure of which is incorporated herein by reference in itsentirety. The proximal ends 64, 66 of the first and second jaws 44, 46each include a pinion gear 68, 70 having a series of teeth. The teeth ofthe pinion 68, 70 mesh with the teeth of the rack 54 of the driver 48such that longitudinal translation of the driver 48 induces rotation inthe first and second jaws 44, 46 relative to one another. Generally,distal translation of the driver 48 causes the first and second jaws 44,46 to rotate outwardly away from each other, while proximal retractionof the driver 48 causes the first and second jaws 44, 46 to rotateinwardly toward one another. Pins 80 are fitted through each theproximal ends of the jaws 44, 46, to pivotally connect the jaws to thehousing 42. Other structures for forming a pivotal connection may beused, and preferably the pivotal connection is centrally arrangedrelative to the pinions 68, 70.

In addition to the jaws 44, 46 being pivotally attached to the housing42, the first and second jaws 44, 46 are also slidably attached to thehousing 42. As best seen in FIGS. 6 and 7 (and in conjunction with FIGS.1-4) the housing 42 defines a first guide surface 82 for the first jaw44, and a second guide surface 84 for the second jaw 46. As seen in FIG.3, the first and second guide surfaces 82, 84 are formed by elongatedslots 82 a, 82 b, 84 a, 84 b formed in opposing sides of the housing 42which leaves a thickness of the housing 42 exposed to serve as the guidesurface. The slots 82 a, 82 b are aligned to receive the connecting pin80 of the first jaw 44, and likewise the slots 84 a, 84 b are aligned toreceive the connecting pin 80 of the second jaw 46. The ends of theslots, for example distal ends 92, 94 shown in FIG. 7, serve to restrictthe longitudinal movement of the jaws 44, 46 relative to the housing 42.The proximal ends 64, 66 of the jaws 44, 46 include apertures 72, 74which receive the pins 80 (FIGS. 1, 2 and 3) that are used to slidablyand pivotally connect the first and second jaws 44, 46 to the housing42.

It can also be seen in FIGS. 6 and 7 that the housing 42 defines a thirdguide surface 86 which guides the longitudinal movement of the driver 48within the housing 42. The guide surface 86 in the depicted embodimentincludes a left guide surface 86 a and a right guide surface 86 b formedas C-shaped channels. As shown in FIG. 7, the third guide surface 86transitions from a smaller proximal width to a larger distal width todefine a shoulder 88 at the transition, which will be further describedhereinbelow with reference to FIGS. 13 and 14.

As also shown in FIG. 6, the internal passageway 43 of the housing 42extends through the distal end of the housing, and through which thefirst and second jaws 44, 46 can extend. Additionally, as shown in FIGS.1 and 2, the housing 42 defines opposing slots 45 which are sized topermit the first and second jaws 44, 46 to pass therethrough when theyrotate radially outwardly. Accordingly, it is also clear from FIGS. 1and 2 that the housing 42 serves to block rotation of the first andsecond jaws 44, 46 when they are entirely or partially contained withinthe internal passageway 43 of the housing 42. Suitable plastics forforming the housing include, but are not limited to,polytetrafluorethylene (PTFE), expanded polytetrafluorethylene (EPTFE),polyethylene ether keytone (PEEK), polyvinylchloride (PVC),polycarbonate (PC), polyamide, polyimide, polyurethane, polyethylene(high, medium or low density), and suitable metals include stainlesssteel, nitinol and similar medical grade metals and alloys.

Operation of the medical device 40 will now be described with referenceto FIGS. 8-12. As shown in FIG. 8, the first and second jaws 44, 46 areshown in a retracted position where they are substantially containedwithin the housing 42. Depending on the application, the distal ends 60,62 of the jaws 44, 46 may slightly project from the distal end of thehousing 42 in their retracted positions, or they may be entirelypositioned within the housing 42. When the drive wire 22 is translateddistally (to the right on the page in FIG. 8) the distal head 32 engagesthe driver 48, and since the rack 54 of the driver 48 is meshed with thepinions 68, 70 at the proximal ends 64, 66 of the jaws 44, 46, thedriver 48 and jaws 44, 46 slide distally through the housing 42 becausethe housing 42 blocks their rotation. As previously mentioned, thislongitudinal movement is guided by the first and second guide surfaces82, 84 which receive the pins 80 that slidably and pivotally connect thejaws 44, 46 to the housing 42.

As shown in FIG. 9, the first and second jaws 44, 46 have an extendedposition where the jaws substantially project from a distal end of thehousing 42, and their proximal ends 64, 66 are positioned adjacent thedistal end of the housing 42. Accordingly, it will be seen that furtherdistal advancement of drive wire 22, and hence the driver 48, causes thepinion 68 to rotate over the teeth 58 of the rack 54. As best seen inFIG. 10, the first and second jaws 44, 46 rotate radially outwardly fromeach other into a tissue receiving position. Notably, due to thepresence of slots 45 at the distal end of the housing 42, the jaws 44,46 are permitted to rotate a full 90°, thus forming at least a 180°between them. It will be recognized that through the sizing of the slots45 and the construction of the rack 54 and pinions 68, 70, the first andsecond jaws 44, 46 may rotate even further away from each other.

In the tissue receiving configuration shown in FIG. 10, the medicaldevice 40 and its jaws 44, 46 may be positioned adjacent tissue T. Asshown in FIG. 11, the tissue T may be placed between the first andsecond jaws 44, 46 and the jaws 44, 46 rotated back towards theirposition shown in FIG. 9. The tissue T has been shown as a single layer,although multiple layers may be clipped between the jaws 44, 46.Generally, proximal retraction of the drive wire 22 and the driver 48again causes rotation of the first and second jaws 44, 46 to grasp thetissue T therebetween. As shown in FIG. 12, further proximal retractionof the drive wire 22 and driver 48 will cause the jaws 44, 46 to movelongitudinally in a proximal direction (to the left on the page in FIG.12).

In order for the medical device 40 to serve as a clip and maintain itsgrasp on the tissue T, or to maintain the clipping of two layers oftissue against each other, the jaws 44, 46 may be locked in position andthe drive wire 22 of the medical system 20 disconnected from the medicaldevice 40. As shown in FIG. 13, the third guide surface 86 (which guidesthe driver 48) includes a proximal portion 86 p and a distal portion 86d. The proximal portion 86 p of the third guide surface 86 has a width(measured up and down on the page in FIG. 13) that is greater than awidth of the distal portion 86 d of the third guide 86. As previouslydiscussed, the third guide surface 86 is formed by opposing surfaces orC-shaped channels 86 a, 86 b of the housing 42. The transition betweenthe proximal portion 86 p and distal portion 86 d defines a shoulder 88,and namely two shoulders 88 a, 88 b on opposing sides of the housing 42.The shoulders 88 a, 88 b are sized and positioned to engage the lockingtabs 52 located on the driver 48.

As shown in FIG. 13, when the driver 48 is located within the distalportion 86 d of the third guide surface 86, the locking tabs 52 areforced radially inwardly into firm frictional engagement with the drivewire 22. Stated another way, the socket 50 formed by the driver 48 toreceive the distal head 32 has an entrance which is narrowed by theinward deflection of the locking tabs 52. In this state depicted in FIG.13, the drive wire 22 is firmly engaged with the driver 48 and hence thefirst and second jaws 44, 46. When the drive wire 22 and driver 48 areretracted proximally, for example upon grasping tissue as shown in FIG.12, the proximal end of the driver 48 is received within the proximalportion 86 p of the third guide surface 86 which has a larger width thatpermits outward movement of the locking tabs 52. Accordingly, in thestate depicted in FIG. 14, the locking tabs 52 may be loosely anddetachably connected to the distal head 32 of the drive wire 22. Thatis, the proximal retraction of the jaws 44, 46 will be limited by eitherthe tissue T engaging the distal end of the housing 42, or the pins 80will abut the proximal ends of the slots 82 a, 82 b, 84 a, 84 b defininga first and second guide surfaces 82, 84. As such, when proximalmovement of the jaws 44, 46 and the driver 48 are thus limited, furtherproximal movement of the drive wire 22 and its distal head 32 may beused to withdraw the distal head 32 from the socket 50 of the driver 48.This operation may also be used to further deflect the locking tabs 52radially outwardly, e.g. via plastic deformation into this outwardposition to maintain the closed configuration of the jaws. In the eventthe natural elasticity of the tissue T tends to pull the jaws 44, 46 outfrom the housing towards their extended position, the locking tabs 52will abut the shoulders 88 a, 88 b of the third guide surface of thehousing 42 to prevent further distal movement of the jaws 44, 46.

Turning now to FIGS. 15 and 16, upon still further proximal retractionof the drive wire 22 and distal head 32, the enlarged distal head 32will abut the connection block 26 which is slidably fitted within thedistal end 23 of the catheter 24. Sufficient proximal force on the drivewire 22 will overcome the frictional fit between the connection block 26and the proximal end of the housing 42, thus moving the connection block26 proximally (to the right on the page of FIGS. 15 and 16) to retractthe connection block 26 within the tubular connector 24, as shown inFIG. 16. The catheter 24 can be used to provide a counterforce on thehousing 42 while proximally retracting the drive wire 22 and connectionblock 26. Accordingly, the drive wire 22, catheter 24 and connectionblock 26 may be fully disconnected from the medical device 40, therebyleaving the first and second jaws 44, 46 and the housing 42 in a statehaving the tissue T clipped between the jaws 44, 46 and retained invivo. The connection block 26 is retained at the distal end 23 of thecatheter 24 via the pins 30, which are positioned within the recessedarea 27 to engage the proximal and distal ends of the connection block26 and limit its longitudinal movement.

The elongated catheter 24 (or other elongate tubular member such as asheath, tube, scope or the like), which slidably encases the drive wire22, extends proximally therealong to a proximal end of the system 20,and has a length suitable for placing the device 40 at any desiredlocation within the body, while the proximal ends of drive wire 22 andcatheter 24 are positioned outside of the body for use by the medicalprofessional. Control handles (not shown) for controlling relativetranslation of the drive wire 22 and catheter 24 are well known in theart, and may be employed at the proximal end of the system 20.

In another embodiment of a medical system 120 shown in FIGS. 17-22, aconnection block 126 is slidably fitted within the distal end 23 of thecatheter 24 (FIGS. 20-22) and defines a bore 128 therethrough (FIG. 18)which slidably receives the drive wire 22. As best seen in FIGS. 17-18,the exterior of the connection block 126 includes a recessed portion 127defining a proximal flange 132 and a distal flange 134. In thisembodiment, the distal flange 134 is larger than the proximal flange 132(longitudinally), and it is slightly smaller than an inner diameter ofthe tubular housing 142 of the clip device 140 (i.e. does not have afriction fit). Here, a connection ring 136 is attached to the distalflange 134 and includes a plurality of tabs 138 which project radiallyoutwardly and connect to the housing 142.

As best seen in FIG. 19, the proximal end of the housing 142 includes aplurality of slots 144 corresponding to the tabs 138 of the connectionring 136. The slots 144 extend longitudinally from the end surface ofthe housing 142 and include a narrowed region or throat 146 that issized to retain the tabs 138 in a distal portion of the slots 144. Aplurality of slits 148 may be formed in the housing 142 at the ends ofthe slots 144 to provide additional flexibility to allow the slots 144to slightly enlarge as the tabs 138 pass through the throats 146 of theslots 144. The housing 142 may be formed of a suitable plastic or metal(or combination thereof) that is sufficiently flexible for passing thetabs 138 into the slots 144, while also being sufficiently rigid to formthe guide surfaces which guide the jaws and driver as previouslydescribed. As shown in the sequence of FIGS. 20-22, the connection blockis initially positioned within the proximal end of housing 142 such thatthe tabs 138 are locked into the distal portions of the slots 144 andheld in place by the throat 146. When the drive wire 22 and its distalhead 32 are retracted proximally to engage the connection block 126(see, e.g., FIGS. 15-16), the connection block 126 is moved proximallyrelative to the housing 142 such that the tabs 138 move past the throats146 and into the proximal portions of the slots 144, as shown in FIG.21. With further proximal movement of the drive wire 22 and/or catheter24, the clip device 40 may be detached from the catheter 24 and drivewire 22, as shown in FIG. 22.

In yet another embodiment of a connection block 226 for a medical system220, shown in FIG. 23, the block 226 again includes a bore 228 and arecessed portion 227 defined by a proximal flange 232 and a distalflange 234. In this embodiment, the distal flange 234 is provided withan O-ring 236 or other similar gasket or compressible member (e.g. adisk or individual tabs made of an elastomer or rubber) that is fittedon the exterior of the distal flange 234. The connection block 226 mayinclude a groove to receive the O-ring 236, or it may be attached viafriction fit, adhesives, bonding techniques such as plastic welding, orother mechanical connecting structures. The O-ring 236 is sized toprovide a friction fit between the connection block and the proximal end244 of the housing 242. The proximal end 244 may also be formed with achamfer 246 or other sloped surface to guide interconnection of theconnection block 226 and the housing 242.

It will be recognized by those skilled in the art that the drive wire 22and its distal head 32 could again be connected to the driver 48 and itssocket 50, thus permitting additional manipulation of the medical deviceto adjust the clipped tissue T. Likewise, additional medical devices maybe attached to the drive wire 22 and tubular connector 24 of the medicalsystem 20 for deployment of the additional medical devices, e.g.multiple devices 40 for clipping the tissue T may be used to close aperforation or achieve hemostasis. Generally, the support ring 34 (FIGS.1-4) fixed on the drive wire 22 can be used to limit the distal movementof the drive wire 22, and can be distally advanced to a positionabutting the connection block 26. As such, the drive wire 22 and supportring 34 can be used to push the connection block 26 distally out of thetubular connector 24 so that it can be attached to the housing (e.g. 42)of a new medical device (e.g. 40), or the previously placed medicaldevice 40. Alternatively, the user may manually press (i.e. with fingersor a tool) the connection block 26 distally out of the tubular connector24 for connection to another medical device.

FIGS. 24-29 depict various alternate embodiments and devices thatfacilitate loading a clip device 40 within the medical system 20 inaccordance with the foregoing. In FIG. 24, a catheter attachment 330takes the form of a tubular member which defines an interior passageway332 which extends therethrough. The proximal end 331 of the catheterattachment 330 is sized to be connected to the distal end of thecatheter 24, as shown in FIG. 25 (e.g. via friction fit, adhesives,plastic bonding or welding, mechanical connectors, etc.). The catheterattachment 330 includes a pair of diametrically opposed openings 334which provide access to the control wire 22 running through the catheter24 and passageway 332, as best seen in FIG. 25. The catheter attachment330 also includes U-shaped cut-outs 336 in four places, the cut-outs 336leaving tabs 338. The tabs 338 may be bent radially inwardly as shown inFIG. 25, and thus can be used to replace the pin 30 in the catheter 24shown in prior embodiments. That is, the tabs 338 project into thepassageway 332 and fit within the recessed portion 127 of the connectionplug 126 as was described with reference to FIG. 17-22. Like the pin 30,the tabs 338 limit the longitudinal movement of the connection block126, while permitting rotation of the connected block 126 and thecontrol wire 22 and catheter 24.

The large openings 334 in the catheter attachment 330 provide access tohold the connection block 126 in an extended position for attachment ofanother clip device 40. Turning to FIG. 26, a locking pin 350 is shownwhich may be positioned through the openings 334 and the catheterattachment 330 for holding the connection block 126 in its extendedposition shown in FIG. 25. The locking pin 350 includes a main body 352having a flange 354 projecting laterally therefrom. From the flange 354projects a forked strut 356 which also projects laterally from the mainbody 352. The forked strut 356 includes two tines 358 that are spacedapart to define a slot 360 therebetween. The slot 360 is sized toreceive the drive wire 22 therein, and are also spaced to be entirelyplaced through the openings 334 in the catheter attachment 330. In thismanner, the locking pin 350 prevents proximal movement of the connectionblock 126 to hold it in place for attachment of another device 40 forclipping the tissue.

FIGS. 27 and 28 depict an applicator 400 for placing the locking pin 350through the opening 334 in the catheter attachment 330. The applicator400 generally includes a left body 402 and a right body 404, each ofwhich define openings 406, 408 for receiving fingers of a medicalprofessional. The left and right bodies 402, 404 are slidably connectedto one another, for example using a plurality of rods 410 projectingfrom the left body 402 which are slidably received within passageways412 formed in the right body 404. The left and right bodies 402, 404also included channels for receiving the catheter 24 and catheterattachment 330 for placement of the locking pin 350. In particular, thechannels include a lower portion 414 which is sized to receive thecatheter 24, and an upper portion 416 which is sized to receive thecatheter attachment 330. The upper channel portions 416 also includedepressions which receive the locking pin 350, and in particular theleft body 402 includes a recess 418 a for receiving the main body 352and flange 354 of the locking pin 350, while the right body 404 includesa recess 418 b for receiving the ends of the tines 358 of the lockingpin 350. Accordingly, and as shown in FIG. 28, the distal end of thecatheter 24 and its catheter attachment 330 may be loaded in thechannels 414, 416, of the right body 404, and then the left body 402moved into engagement with the right body 404 such that the locking pin350 is placed through the openings 334 in the catheter attachment 330such that the tines 358 extend around the control wire 22 and theproximal movement of the connection block 126 is prevented, thusallowing the housing 42, 142 of a clip device 40, 140 to be pressed ontothe connection block 26, 126, 226.

Finally, FIG. 29 depicts a perspective view of another embodiment of anapplicator 500 for maintaining the connection block 26, 126, 226 in anextended position. As with the embodiment of FIGS. 24-28, the catheter24 includes a catheter attachment 330 as previously described. Here, theapplicator 500 is a single grasping member 502 which has recesses 504 onopposing sides for grasping between two fingers of the medicalprofessional. The recesses 504 open to one side of the body 502, whilethe opposing side includes a fork strut 556 having two tines 558 spacedapart to define a slot 560. As with the prior embodiment, the tines 558are sized to be passed through the openings 334 in the catheterattachment 330 such that the drive wire 22 is received within the slot560, whereby proximal movement of the connection block 126 is blocked tomaintain its extended position for attachment of another device 40 forclipping tissue.

Additional embodiments of the connection/disconnection mechanisms andthe medical system 20 may be found in copending U.S. Appl. No.61/391,875 and Appl. No. 61/391,881, the disclosures of which are herebyincorporated by reference in their entirety.

The foregoing description of various embodiments of the invention hasbeen presented for purposes of illustration and description. It is notintended to be exhaustive or to limit the invention to the preciseembodiments disclosed. Numerous modifications or variations are possiblein light of the above teachings. The embodiments discussed were chosenand described to provide the best illustration of the principles of theinvention and its practical application to thereby enable one ofordinary skill in the art to utilize the invention in variousembodiments and with various modifications as are suited to theparticular use contemplated. All such modifications and variations arewithin the scope of the invention as determined by the appended claimswhen interpreted in accordance with the breadth to which they arefairly, legally, and equitably entitled.

The invention claimed is:
 1. A medical system for engaging tissue, themedical system comprising: a housing defining an internal passageway anda longitudinal axis extending between proximal and distal ends of thehousing, the housing including a guide surface along the internalpassageway, the guide surface including a proximal section and a distalsection, the distal section having a smaller effective diameter than theproximal section of the guide surface; a first jaw pivotally connectedto the housing, the first jaw having proximal and distal ends; a secondjaw pivotally connected to the housing, the second jaw having proximaland distal ends; a driver engaged with the proximal ends of the firstand second jaws, longitudinal movement of the driver rotating the firstand second jaws relative to the housing between an open and a closedposition, the longitudinal movement of the driver guided by the guidesurface of the housing, the driver including a socket facing proximallyand constructed of a resilient material that is flexible; an elongateddrive wire selectively connected to the driver for longitudinal movementtherewith, the drive wire having an enlarged portion proximate a distalend of the drive wire, the enlarged portion selectively received withinthe socket of the driver; and the socket operable between first, secondand third states, the first state comprising a natural state where thesocket releasably engages the drive wire, the second state comprising acompressed state where the socket non-releasably engages the drive wire,and the third state comprising an expanded state where the socket isdisengaged from the enlarged portion of the drive wire, wherein thefirst and second jaws are maintained in the closed position when thesocket is in the third state; and wherein the first and second jaws areslidably and pivotally connected to the housing, and wherein the firstand second jaws are non-detachably connected to the housing; and whereinthe first and second jaws are longitudinally movable relative to thehousing between a retracted position and an extended position, the firstand second jaws being mostly disposed within the internal passageway ofthe housing in the retracted position, the first and second jaws beingmostly disposed distally of the internal passageway of the housing whenin the extended position; and wherein longitudinal movement of thedriver moves the first and second jaws between the retracted positionand the extended position.
 2. The medical system of claim 1, wherein theproximal section of the guide surface is sized relative to the socketsuch that, when the socket is within the proximal section and in itsnatural state, the socket releasably engages the enlarged portion of thedrive wire.
 3. The medical system of claim 1, wherein the distal sectionof the guide surface is sized relative to the socket such that, when thesocket is within the distal section, the socket non-releasably engagesthe enlarged portion of the drive wire.
 4. The medical system of claim1, wherein the driver includes a locking tab positioned at an entranceto the socket that moves to vary the size of the entrance, and whereinthe locking tab is moved radially inwardly when the driver and socketmove distally from the proximal section to the distal section of theguide surface.
 5. The medical system of claim 4, wherein the distalsection of the guide surface is sized relative to the socket such that,when the socket is within the distal section, the locking tab is pressedagainst the drive wire.
 6. The medical system of claim 4, wherein thedriver includes two locking tabs on opposing sides of the entrance tothe socket, and wherein the two locking tabs are moved radially inwardlyby the distal section of the guide surface.
 7. The medical system ofclaim 4, wherein the housing defines a shoulder at a transition betweenthe proximal section and distal section of the guide surface, andwherein the locking tab is positioned to engage the shoulder to limitlongitudinal movement of the driver.
 8. The medical system of claim 4,wherein the locking tab is plastically deformable.
 9. The medical systemof claim 4, wherein the shoulder deflects the tab radially inwardly to aposition into engagement with the drive wire when a distally directedlongitudinal force on the driver reaches a predetermined force to permitlongitudinal movement of the driver and the first and second jaws in adistal direction.
 10. The medical system of claim 9, wherein, when thesocket is located in the proximal section of the guide surface and aproximally directed longitudinal force on the drive wire reaches apredetermined force, the enlarged portion of the drive wire deflects thetab radially outwardly such that the drive wire is in the third stateand disengaged from the driver.
 11. The medical system of claim 1,wherein the guide surface is defined by two grooves formed on oppositesides of the internal passageway.
 12. The medical system of claim 1,wherein an internal surface of the housing engage an exterior surface ofthe first and second jaws to maintain the first and second jaws in theclosed position when the first and second jaws are in the retractedposition.
 13. A medical system for engaging tissue, the medical systemcomprising: a housing defining an internal passageway and a longitudinalaxis extending between proximal and distal ends of the housing, thehousing including a guide surface along the internal passageway, a firstjaw pivotally connected to the housing, the first jaw having proximaland distal ends; a second jaw pivotally connected to the housing, thesecond jaw having proximal and distal ends; a driver engaged with theproximal ends of the first and second jaws, longitudinal movement of thedriver rotating the first and second jaws relative to the housingbetween an open and a closed position, the longitudinal movement of thedriver guided by the guide surface of the housing, the driver includinga socket facing proximally and constructed of a resilient material thatis flexible; an elongated drive wire selectively connected to the driverfor longitudinal movement therewith, the drive wire having an enlargedportion proximate a distal end of the drive wire, the enlarged portionselectively received within the socket of the driver, the socket havinga natural state where the socket is detachably engaged with the driver,wherein the first and second jaws are disposed in the closed positionwhen the socket is in the natural state; and wherein the first andsecond jaws are both slidably and pivotally connected to the housing,the first and second jaws configured to slide longitudinally relative tothe housing; and wherein the first and second jaws are longitudinallymovable relative to the housing between a retracted position and anextended position, the first and second jaws being mostly disposedwithin the internal passageway of the housing in the retracted position,the first and second jaws being mostly disposed distally of the internalpassageway of the housing when in the extended position; and whereinlongitudinal movement of the driver moves the first and second jawsbetween the retracted position and the extended position.
 14. Themedical system of claim 13, wherein the medical system is operablebetween first, second and third configurations, the socket of the drivernon-detachably engaged with the drive wire in the first configuration,the socket of the driver detachably engaged with the drive wire in thesecond configuration, and the driver detached from the drive wire in thethird configuration, and wherein the driver includes a locking tabpositioned at an entrance to the socket that moves to vary the size ofthe entrance, and wherein the entrance has a smallest size in the firstconfiguration, and a largest size in the third configuration.
 15. Themedical system of claim 14, wherein the locking tab is pressed againstthe drive wire in the first configuration.
 16. The medical system ofclaim 14, wherein the guide surface includes a proximal section and adistal section, the distal section having a smaller effective diameterthan the proximal section of the guide surface.
 17. The medical systemof claim 13, wherein an internal surface of the housing engage anexterior surface of the first and second jaws to maintain the first andsecond jaws in the closed position when the first and second jaws are inthe retracted position.